Correcting Low Milk Supply

There are several positive steps you can take if you decide that your milk supply is low. If possible, plan to set aside a few days, perhaps a weekend, to spend doing little else but working to increase your milk production. Following the steps listed below, most moms notice an increase in supply within 24-72 hours. If you're pumping and just finding it harder to keep up with your baby's milk needs, although your baby seems fine when he nurses, the following will also apply.

·        Nurse or pump frequently. Plan to nurse at least every 1 1/2 to 2 hours during the day and at least every 3 hours at night even if you must awaken your baby. Time your feedings from the beginning of one to the beginning of another. If your baby is available to nurse, this is preferable to pumping as he will better stimulate your breasts to produce more milk.  Prolactin is the milk-making hormone. Maternal prolactin levels peak between 1 and 5 A.M. Take advantage of these high prolactin levels by nursing more frequently at night to help stimulate your milk supply.

·        Allow the baby to nurse on each side until he pulls off himself or goes to sleep.

·        Offer both breasts at each feeding.

·        Although nursing is preferable, if the baby cannot nurse directly at the breast, use a hospital-grade electric pump for double pumping instead (such as the Ameda Purely Yours or the Medela Pump In Style). Double pumping has been shown to increase Prolactin levels. Prolactin is the hormone which stimulates milk production. Pump for 10-15 minutes per session. Longer sessions have not been proven to be any more beneficial at increasing supply.

·        Along with nursing, you may want to add another pumping session or two sometime during your day. You also may want to add a few extra minutes (5-10) of pumping after the baby has finished nursing. For working mothers, increase the frequency of pumping sessions during the day. Try getting to work 10 minutes early, and add one pumping session before starting work. Pump for 10 minutes, 4 times per day instead of 10 minutes 3 times per day. If your baby is sleeping through the night, try setting an alarm for 3 A.M. and wake up to pump for 10 minutes. Your prolactin levels go up while you are asleep, so your body makes more milk at night. Be sure to drink a glass of water when you pump during the night. Your body will think your baby is going through a growth spurt!

·        Allow the baby to meet all of his sucking needs at the breast. Avoid any bottles or pacifiers during this time. Your baby's need to suck ensures that he spends adequate time at the breast to stimulate your supply.

·        Avoid supplements including solid food, water, juice, and formula. Adding these will result in your baby nursing less often and you getting less stimulation. You can be sure that your baby is getting enough by counting his wet diapers and bowel movements.

·        If your baby requires a supplement for medical reasons, consider using a nursing supplementer at your breast so that you can continue to receive crucial BABY stimulation.

·        Snack often on foods rich in protein and calcium. Eat snacks such as yogurt, cheese, nuts, and fruit throughout the day.

      Perhaps you've heard Oatmeal or beer will increase supply. Brewers Yeast (used in making beer) and Oatmeal, Barley and Navy Beans, Wheat Germ and Lecithin all have a nutrient called Inositol. Inositol deficiency can cause problems with lactation, so this is helpful to some women with supply issues. (Though, much to the dissapointment of many women, Brewers Yeast tablets would probably help more than beer.)

·        Drink enough to satisfy your thirst. Forcing fluids is not necessary and may have the opposite effect. Any type of fluid is satisfactory.

·        Rest as much as you can. Consider taking the baby to bed with you for the time period. The rest will benefit you and the close skin-to-skin contact may encourage him to nurse more often.

·        Some mothers have found that the herb, Fenugreek, is helpful for increasing milk supply. It works best when combined with increased frequency of nursing and/or pumping. You can find it at your local health food store or nutrition store. The dosage is 2-4 capsules 3 times a day. Most moms notice an increase in supply after using it 1-3 days. It is safe for your baby. While taking it you may notice that your perspiration and urine smell like maple syrup as Fenugreek is used to give artificial Maple syrup its odor. Some moms report diarrhea while taking it that quickly resolves once they stop taking it. If you suffer from asthma, your symptoms may become worse with the Fenugreek. Dosages higher than the recommended one given above may result in hypoglycemia in some mothers. If pregnant, you should NOT use Fenugreek as it may cause uterine contractions. Many moms use it for a quick boost to their supplies. Others have used it long-term with no problems. Other herbs often recommended for increasing milk supply are Blessed Thistle and Alfalfa. For some mothers a combination of herbs seems to work better than one herb alone. You may use the Fenugreek, Blessed Thistle, and Alfalfa in combination if you choose.

• Are you taking birth control pills? Some women have found that even the "mini-pill" (progestin only) can have a negative effect on their milk supply.
  If you are separated from your baby during the day, try pumping after you nurse your baby in the morning or evening for extra stimulation.

For Pumpers

• Drink more water, get more rest, and try to relax while pumping or nursing. At work, listen to your favorite music and look at a picture of your baby while you pump. You can also try putting your head down on the desk or leaning over while you pump. This will help you relax and allow gravity to assist in the milk collection process.

• Try pumping only one breast at a time for a few days. Use your "free" hand to gently massage the breast that is being pumped or nursed from. Also, you can change the position of the collection funnel by angling the bottle to the side of your breast during pumping. Change positions several times during pumping. This will help empty the ducts more completely. It takes longer to pump with this method, but after a week you can switch back to double pumping.

• If you are pumping, use the "Massage-Stroke-Shake" technique as taught by Chele Marmet, who is the co-director of the Lactation Institute in Encino, CA. Double pump for 5-7 minutes. Stop. Massage both breasts simultaneously in a circular motion similar to a breast self-exam. Then stroke both breasts all the way around from the chest wall to the tip of the nipple in a straight line using only your fingertips. Next, cup each breast with your hand, lean forward, and gently shake your breasts. Pump for another 5-7 minutes and repeat the M-S-S technique. Finish by pumping 5-7 minutes.

If your pump parts include flange inserts for smaller areola, use the inserts for the middle pumping to stimulate the areola and the milk sinuses located behind the nipple. The hands-on, M-S-S technique stimulates an increase in prolactin levels, which in turn increases milk production.

This method ensures a more complete emptying of the breast, which stimulates the body to begin producing more milk. Mothers who have used this technique report an increase in milk supply within 2-3 days.

If you've tried every single one of the techniques listed above, and still find that you have supply problems, you may then want to consider drug therapy, such as Reglan or Domperidone.  Both work to increase milk supply dramatically by inhibiting the production of dopamine in the brain, thereby increasing the amount of prolactin. 

 These drugs will not work without frequent stimulation by the nursing baby or at least the pump.  The drug does not increase the prolactin, it inhibits the dopamine, which allows the baby to increase prolactin.  No supply increase strategy will work without frequent stimulation by the nursing baby.  See our article on how milk production works.

Reglan is a drug frequently used to treat reflux.  It has several unfortunate side effects, including depression, anxiety, and drowsiness.  Domperidone, on the other hand, work in the same way, but without any of the aforementioned side-effects.  The most reported side effect is headache, and that only with higher than recommended doses.  Unfortunately, domperidone is FDA approved in the United States.  It is obtainable by prescription only at compounding pharmacies, but it is almost impossible to convince the average doctor to prescribe it and it costs an exorbitant amount of money. 

The story goes that it costs literally millions of dollars to push something through the FDA's approval process.  Since there is already an adequate FDA approved drug (Reglan) for the intended purpose (treating reflux), no one is willing to spend the money on the approval of domperidone.  Domperidone is widely used in other countries, including Canada, under the brand name Motilium.  US residents may purchase the drug from Canada, with a prescription from their doctors.  It is also available by mail order from Mexico.  However, the most affordable country from which to purchase the drug is New Zealand.  There is a wonderful pharmacy there with internet ordering capabilities,  Global Drug.  I have no affiliation with them other than as a satisfied customer.  I have required Domperidone to support breastfeeding with both of my children.  I have one hypoplastic breast and this drug is the only thing that made it possible for me to do the most wonderful thing I have ever done, breastfeed my little babies.

Jessica Hudson is Owner of Eva Lillian Maternity

She lives in Lansing, MI with her husband, son, and new daughter Eva